All patients are not created equal Many emergency departments and hospitals in low socioeconomic areas, sometimes referred to as “safety net hospitals,” have closed, resulting in serious problems for poor and minority populations due to reduced or no access to emergency care. This results in exacerbating illness or injury due to either waiting time to get, or failing to seek, medical attention. When patients later become desperate, ambulance calls increase; emergency rooms in distant hospitals become overcrowded; all resulting in further delayed emergency room care. Medical specialists have become more reluctant to be on-call out of concern for overburdened emergency…

July 27, 2011 ASCO Urges Policymakers to Protect Patient Access to Cancer Care from Debt Ceiling Negotiation Package The American Society of Clinical Oncology (ASCO ) is deeply concerned about the proposed $3 billion in cuts to Medicare reimbursement as part of a debt ceiling negotiation package. If the cuts are put into place, patient access to cancer care will be threatened as previous cuts to Medicare have already caused oncology practices to close, consolidate and turn away Medicare patients. ASCO is closely monitoring the situation, and advocating on behalf of oncology practices and patients. This week, ASCO placed print…

Red Flags Rules require financial institutions and businesses that give credit to consumers to establish some sort of program or procedure to identify customers who may be involved in identity theft. Since most medical providers provide medical services and allow the patient to pay their bill at a later time, and in concert with insurance benefits, the FTC intends to treat medical practice as a “creditor” and thus come within the scope of Red Flag rules. “Creditor” is defined by this law as any business or organization that defers payments for goods or services.” On May 21, 2010…

It has been 17 years since this bill was first introduced. The New York State Senate will pass the Family Health Care Decisions Act (FHCDA), setting forth clear guidelines for family members and others close to the patient to make medical decisions for incapacitated patients. It will also provide physicians with uniform protocols to follow. In many instances there will continue to be confusion and concern for the rights of the patient. Diligent and thoughtful efforts will be needed to apply these guidelines properly. The following are some of the important points for clinicians: If there is disagreement about…

New Reform Medical Center Serving your Community since 2010 Agreement and Release As you enter this Hospital you understand, acknowledge and agree that this hospital rations medical care and services. This means that the hospital and physicians can determine that you may not be entitled to certain medical treatment, even if it is of benefit to you. Your physicians and hospital may conclude that medical costs to the community outweigh the benefits of the otherwise beneficial medical treatment for you, if one or more of the following criteria exist: Age, (younger than 5 or older than 68); Mental…

At the 42d meeting of the American Society of Nephrology in San Diego this week, entitled “Renal Week,” Elisa J. Gordon, PhD, MPH, of Northwestern University presented a study on informed consent, that found that “kidney transplant consent forms are written at considerably higher reading levels than they should be.” She is of the view that consent forms should be written at a 5th to 8th grade reading to ensure that transplant candidates are well informed about transplantation processes, understand the material, and can provide informed consent. My concern is that many physicians see forms as a satisfactory replacement for…

A South Korean Ethics Committee uses a staged approach to Withdrawing Life Support In follow up to this blog’s April 23, 2009 post: “Letting the Conscious But Incompetent, Non Terminally Ill, Patient Die.” A South Korean hospital used a staged approach to consider the withdrawal of artificial life support based upon the condition of the patient. On June 11, 2009 an Ethics Committee at the Yonsei University Severance Hospital in Seoul Korea decided to remove a 77-year-old woman in a vegetative state from a respirator in accordance with a Supreme Court ruling. Severance Hospital President Park Chang-il said: “Though we…

I agree with the court’s rulings in the case of Daniel Hauser, highlighted in the media recently. In this case there is as absolute need to continue chemotherapy. It should however be pointed out that the Court ignored Mrs. Hauser’s demand for confidentiality and contributed to this case becoming a spectacle in the media and making Mrs. Hauser the focus of overwhelming media attention, pitting her beliefs against most of the country’s. This injudicious conduct may have contributed to the panic of the mother to leave the jurisdiction and hide herself and her son. The legal issues in this case…

HEALTH AND SAFETY CODE CHAPTER 166.039. PROCEDURE WHEN PERSON HAS NOT EXECUTED OR ISSUED A DIRECTIVE AND IS INCOMPETENT OR INCAPABLE OF COMMUNICATION For the most vulnerable patients, without friends or family, life for some medical patients in Texas, is cheap. On vague and specious grounds and without proper oversight or transparency, physicians may withdraw life sustaining treatment from a patient, even if the patient is conscious, talking, and aware of his or her surroundings. This statute allows this to occur if a physician treating the patient concludes that the patient will die within six months and there is no…

It must not be too easy to withhold life sustaining treatment from any patient. When it comes to a conscious patient, who is not suffering from a terminal illness, we have to be unquestionably sure we know what we are doing. A consulting physician contacted me expressing great concern that a 60 year old female patient who would likely die without surgery was being discharged. He said, “The patient is not terminal and is treatable. She needs surgery to survive – probably amputation of one or both lower extremities. The family wants her to be discharged home for…

Bernard W. Freedman, J.D.,M.P.H. is an attorney at law and an active member of the California State Bar since 1976. (State Bar number 70888). He has specialized in medical legal law and acted as consultant in clinical bioethics and...More...